Flinders Medical Centre, Bedford Park, SA 5042, Australia; South Australia Medical Imaging, Adelaide, SA 5000, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia; Queen Elizabeth Hospital, Woodville, SA 5011, Australia.
Flinders Medical Centre, Bedford Park, SA 5042, Australia; University of Adelaide, Adelaide, SA 5005, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
J Clin Neurosci. 2024 Nov;129:110810. doi: 10.1016/j.jocn.2024.110810. Epub 2024 Sep 3.
The diagnostic potential of paramagnetic rim lesions (PRLs) has been previously established; however, the prognostic significance of these lesions has not previously been consistently described. This study aimed to establish the prognostic role of PRLs in MS with respect to the Expanded Disability Status Scale (EDSS) and rates of disability progression. Databases of PubMed, EMBASE, Scopus and reference lists of selected articles were searched up to 29/04/2023. The review was conducted in accordance with PRISMA guidelines and was registered prospectively on PROSPERO (CRD42023422052). 7 studies were included in the final review. All of the eligible studies found that patients with PRLs tend to have higher baseline EDSS scores. Longitudinal assessments revealed greater EDSS progression in patients with PRLs over time in most studies. However, the effect of location of PRLs within the central nervous system were not assessed across the studies. Only one study investigated progression independent of relapse activity (PIRA) and showed that this clinical entity occurred in a greater proportion in patients with PRLs. This review supports PRLs as a predictor of EDSS progression. This measure has widespread applicability, however further multicentre studies are needed. Future research should explore the impact of PRLs on silent disability, PIRA, take into account different MS phenotypes and the topography of PRLs in prognosis.
顺磁性边缘病灶 (PRL) 的诊断潜力此前已得到证实；然而，这些病灶的预后意义尚未得到一致描述。本研究旨在确定 PRL 在多发性硬化症（MS）中与扩展残疾状况量表（EDSS）和残疾进展率相关的预后作用。截至 2023 年 4 月 29 日，对 PubMed、EMBASE、Scopus 数据库和选定文章的参考文献进行了检索。该综述按照 PRISMA 指南进行，并在 PROSPERO（CRD42023422052）上进行了前瞻性注册。最终综述纳入了 7 项研究。所有合格的研究都发现，PRL 患者的基线 EDSS 评分往往更高。大多数研究显示，随着时间的推移，PRL 患者的 EDSS 进展更大。然而，研究并未评估 PRL 在中枢神经系统内的位置对疾病的影响。只有一项研究调查了与复发活动无关的进展（PIRA），并表明 PIRA 在 PRL 患者中更为常见。本综述支持 PRL 作为 EDSS 进展的预测因子。这种测量方法具有广泛的适用性，但需要进一步的多中心研究。未来的研究应探讨 PRL 对隐匿性残疾、PIRA 的影响，考虑不同的 MS 表型和 PRL 在预后中的分布。
